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Coronal vertical fracture of vertebral body following minimally invasive lateral lumbar interbody fusion: risk factor analysis in consecutive case series

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Abstract

Background

To investigate the incidence and risk factors of coronal vertical vertebral body fracture (CV-VBF) during lateral lumbar interbody fusion (LLIF) for degenerative lumbar disease.

Methods

Clinical data, including age, sex, body mass index, and bone mineral density, were reviewed. Radiological assessments, such as facet joint arthrosis, intervertebral disc motion, index disc height, and cage profiles, were conducted. Posterior instrumentation was performed using either a single or staged procedure after LLIF. Demographic and surgical data were compared between patients with and without VBF.

Results

Out of 273 patients (552 levels), 7 (2.6%) experienced CV-VBF. Among the 552 levels, VBF occured in 7 levels (1.3%). All VBF cases developed intraoperatively during LLIF, with no instances caused by cage subsidence during the follow-up period. Sagittal motion in segments adjacent to VBF was smaller than in others (4.6° ± 2.6° versus 6.5° ± 3.9°, P = 0.031). The average grade of facet arthrosis was 2.5 ± 0.7, indicating severe facet arthrosis. All fractures developed due to oblique placement of a trial or cage into the index disc space, leading to a nutcracker effect. These factors were not related to bone quality.

Conclusions

CV-VBF after LLIF occurred in 2.6% of patients, accounting for 1.3% of all LLIF levels. A potential risk factor for VBF involves the nutcracker-impinging effect due to the oblique placement of a cage. Thorough preoperative evaluations and surgical procedures are needed to avoid VBF when considering LLIF in patients with less mobile spine.

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Data availability

The corresponding author is having the available data.

Code availability

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea

    Kee-Yong Ha, Young-Hoon Kim & Sang-Il Kim

  2. Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea

    Yong-Chan Kim

  3. Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Hyung-Youl Park

  4. Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Hyun Bae

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  1. Kee-Yong Ha
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Contributions

Kee-Yong Ha: conceptualization, methodology, writing.

Young-Hoon Kim: data curation, supervision.

Yong-Chan Kim: original draft preparation.

Hyung-Youl Park: investigation.

Hyun Bae: validation.

Sang-Il Kim: writing and revision.

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Correspondence to Sang-Il Kim.

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Ha, KY., Kim, YH., Kim, YC. et al. Coronal vertical fracture of vertebral body following minimally invasive lateral lumbar interbody fusion: risk factor analysis in consecutive case series. Acta Neurochir 166, 143 (2024). https://doi.org/10.1007/s00701-024-06043-9

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